Abstract
Cardiac dysfunction has an increased prevalence in diseases complicated by liver cirrhosis such as primary biliary cholangitis and primary sclerosing cholangitis. This observation has led to research into the association between abnormalities in bile acid metabolism and cardiac pathology. Approximately 50% of liver cirrhosis cases develop cirrhotic cardiomyopathy. Bile acids are directly implicated in this, causing QT interval prolongation, cardiac hypertrophy, cardiomyocyte apoptosis and abnormal haemodynamics of the heart. Elevated maternal serum bile acids in intrahepatic cholestasis of pregnancy, a disorder which causes an impaired feto-maternal bile acid gradient, have been associated with fatal fetal arrhythmias. The hydrophobicity of individual bile acids in the serum bile acid pool is of relevance, with relatively lipophilic bile acids having a more harmful effect on the heart. Ursodeoxycholic acid can reverse or protect against these detrimental cardiac effects of elevated bile acids.
Keywords:
Bile acids; Cirrhotic cardiomyopathy; Intrahepatic cholestasis of pregnancy; Primary biliary cholangitis; Primary sclerosing cholangitis; Ursodeoxycholic acid.
Copyright © 2018 Elsevier B.V. All rights reserved.
Publication types
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Research Support, Non-U.S. Gov't
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Review
MeSH terms
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Apoptosis / drug effects
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Arrhythmias, Cardiac / etiology*
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Arrhythmias, Cardiac / prevention & control
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Bile Acids and Salts / blood
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Bile Acids and Salts / chemistry
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Bile Acids and Salts / metabolism*
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Cardiomyopathies / blood
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Cardiomyopathies / epidemiology
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Cardiomyopathies / etiology*
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Cardiomyopathies / prevention & control
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Cholagogues and Choleretics / pharmacology
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Cholagogues and Choleretics / therapeutic use
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Cholangitis / blood
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Cholangitis / complications
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Cholangitis / drug therapy
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Cholangitis / metabolism*
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Cholestasis, Intrahepatic / blood
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Cholestasis, Intrahepatic / complications*
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Cholestasis, Intrahepatic / drug therapy
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Cholestasis, Intrahepatic / metabolism
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Female
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Heart / drug effects
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Heart / physiopathology
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Hemodynamics / drug effects
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Humans
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Hydrophobic and Hydrophilic Interactions
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Liver Cirrhosis, Biliary / blood
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Liver Cirrhosis, Biliary / complications
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Liver Cirrhosis, Biliary / drug therapy
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Liver Cirrhosis, Biliary / metabolism*
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Maternal-Fetal Exchange
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Myocytes, Cardiac / pathology
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Pregnancy
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Pregnancy Complications / blood
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Pregnancy Complications / drug therapy
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Pregnancy Complications / metabolism
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Prevalence
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Ursodeoxycholic Acid / pharmacology
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Ursodeoxycholic Acid / therapeutic use
Substances
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Bile Acids and Salts
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Cholagogues and Choleretics
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Ursodeoxycholic Acid
Supplementary concepts
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Intrahepatic Cholestasis of Pregnancy